CHAPTER 26.1-36.5HEALTH COVERAGE FOR CHILDREN26.1-36.5-01. Definition. For purposes of this chapter, unless the context otherwiserequires, "insurer" means any health insurer, including a group health plan, as defined in section<br>607(1) of the Employee Retirement Income Security Act of 1974 [Pub. L. 99-272; 100 Stat. 281;<br>29 U.S.C. 1167(1)], a health maintenance organization as defined in section 26.1-18.1-01, a<br>health service corporation as defined in section 26.1-17-01, and a provider of an accident and<br>health insurance policy as defined in section 26.1-36-03.26.1-36.5-02. Prohibited practices.1.No insurer may deny enrollment of a child under the health coverage of the child's<br>parent on the grounds that:a.The child was born out of wedlock;b.The child is not claimed as a dependent on the parent's federal income tax<br>return; orc.The child does not reside with the parent or in the insurer's service area.2.Any provision in an individual or group accident and health insurance policy,<br>nonprofit health service contract, or group health plan issued by any insurer that<br>conflicts with subsection 1 is void.26.1-36.5-03. Enrollment of children. If a parent is required by a court or administrativeorder to provide health coverage for a child and the parent is eligible for family health coverage<br>through an insurer, the insurer shall:1.Permit the parent to enroll under family coverage any child who is otherwise eligible<br>for coverage without regard to any open enrollment restrictions and subject to the<br>prohibited practices provisions of this chapter;2.If a parent fails to provide health coverage for any child, enroll the child under family<br>coverage upon application by the child's other parent or by the department of human<br>services;3.Upon receipt of the national medical support notice issued under section<br>14-09-08.20 from the employer:a.Comply with the provisions of the national medical support notice;b.Within forty business days of the date of the national medical support notice,<br>take appropriate action pursuant to the notice; andc.Enroll the child, and the obligor if necessary, in the insurer's default plan, if any,<br>if required under subsection 2 of section 14-09-08.20; and4.Not disenroll or eliminate coverage for any child unless the insurer is provided<br>satisfactory written evidence that:a.The court or administrative order is no longer in effect; orb.The child is or will be enrolled with comparable coverage that will take effect no<br>later than the effective date of disenrollment.Page No. 126.1-36.5-04. Providing information and paying claims. If a child has health coveragethrough the insurer of a noncustodial parent, the insurer shall:1.Provide information to the custodial parent as may be necessary for the child to<br>obtain benefits through the health coverage;2.Permit the custodial parent, the provider of health care, with the custodial parent's<br>approval, or the department of human services, as the custodial parent's assignee,<br>to submit claims for covered services without the approval of the noncustodial<br>parent; and3.Make payment on claims submitted in accordance with subsection 2 directly to the<br>custodial parent, provider, or department, as their interests may appear.26.1-36.5-05.Authority and jurisdiction.This chapter is adopted pursuant to therequirements of sections 4301 and 13623 of Public Law 103-66 [107 Stat. 312; 29 U.S.C. 1161<br>et seq. and 42 U.S.C. 1396g-1]. The commissioner may take any action reasonably necessary<br>to enforce this chapter and section 26.1-36-12. Any insurer subject to the provisions of this<br>chapter or section 26.1-36-12 must submit to the jurisdiction of the commissioner and to the<br>courts of this state to the greatest extent permitted under state or federal law.Page No. 2Document Outlinechapter 26.1-36.5 health coverage for children
CHAPTER 26.1-36.5HEALTH COVERAGE FOR CHILDREN26.1-36.5-01. Definition. For purposes of this chapter, unless the context otherwiserequires, "insurer" means any health insurer, including a group health plan, as defined in section<br>607(1) of the Employee Retirement Income Security Act of 1974 [Pub. L. 99-272; 100 Stat. 281;<br>29 U.S.C. 1167(1)], a health maintenance organization as defined in section 26.1-18.1-01, a<br>health service corporation as defined in section 26.1-17-01, and a provider of an accident and<br>health insurance policy as defined in section 26.1-36-03.26.1-36.5-02. Prohibited practices.1.No insurer may deny enrollment of a child under the health coverage of the child's<br>parent on the grounds that:a.The child was born out of wedlock;b.The child is not claimed as a dependent on the parent's federal income tax<br>return; orc.The child does not reside with the parent or in the insurer's service area.2.Any provision in an individual or group accident and health insurance policy,<br>nonprofit health service contract, or group health plan issued by any insurer that<br>conflicts with subsection 1 is void.26.1-36.5-03. Enrollment of children. If a parent is required by a court or administrativeorder to provide health coverage for a child and the parent is eligible for family health coverage<br>through an insurer, the insurer shall:1.Permit the parent to enroll under family coverage any child who is otherwise eligible<br>for coverage without regard to any open enrollment restrictions and subject to the<br>prohibited practices provisions of this chapter;2.If a parent fails to provide health coverage for any child, enroll the child under family<br>coverage upon application by the child's other parent or by the department of human<br>services;3.Upon receipt of the national medical support notice issued under section<br>14-09-08.20 from the employer:a.Comply with the provisions of the national medical support notice;b.Within forty business days of the date of the national medical support notice,<br>take appropriate action pursuant to the notice; andc.Enroll the child, and the obligor if necessary, in the insurer's default plan, if any,<br>if required under subsection 2 of section 14-09-08.20; and4.Not disenroll or eliminate coverage for any child unless the insurer is provided<br>satisfactory written evidence that:a.The court or administrative order is no longer in effect; orb.The child is or will be enrolled with comparable coverage that will take effect no<br>later than the effective date of disenrollment.Page No. 126.1-36.5-04. Providing information and paying claims. If a child has health coveragethrough the insurer of a noncustodial parent, the insurer shall:1.Provide information to the custodial parent as may be necessary for the child to<br>obtain benefits through the health coverage;2.Permit the custodial parent, the provider of health care, with the custodial parent's<br>approval, or the department of human services, as the custodial parent's assignee,<br>to submit claims for covered services without the approval of the noncustodial<br>parent; and3.Make payment on claims submitted in accordance with subsection 2 directly to the<br>custodial parent, provider, or department, as their interests may appear.26.1-36.5-05.Authority and jurisdiction.This chapter is adopted pursuant to therequirements of sections 4301 and 13623 of Public Law 103-66 [107 Stat. 312; 29 U.S.C. 1161<br>et seq. and 42 U.S.C. 1396g-1]. The commissioner may take any action reasonably necessary<br>to enforce this chapter and section 26.1-36-12. Any insurer subject to the provisions of this<br>chapter or section 26.1-36-12 must submit to the jurisdiction of the commissioner and to the<br>courts of this state to the greatest extent permitted under state or federal law.Page No. 2Document Outlinechapter 26.1-36.5 health coverage for children
CHAPTER 26.1-36.5HEALTH COVERAGE FOR CHILDREN26.1-36.5-01. Definition. For purposes of this chapter, unless the context otherwiserequires, "insurer" means any health insurer, including a group health plan, as defined in section<br>607(1) of the Employee Retirement Income Security Act of 1974 [Pub. L. 99-272; 100 Stat. 281;<br>29 U.S.C. 1167(1)], a health maintenance organization as defined in section 26.1-18.1-01, a<br>health service corporation as defined in section 26.1-17-01, and a provider of an accident and<br>health insurance policy as defined in section 26.1-36-03.26.1-36.5-02. Prohibited practices.1.No insurer may deny enrollment of a child under the health coverage of the child's<br>parent on the grounds that:a.The child was born out of wedlock;b.The child is not claimed as a dependent on the parent's federal income tax<br>return; orc.The child does not reside with the parent or in the insurer's service area.2.Any provision in an individual or group accident and health insurance policy,<br>nonprofit health service contract, or group health plan issued by any insurer that<br>conflicts with subsection 1 is void.26.1-36.5-03. Enrollment of children. If a parent is required by a court or administrativeorder to provide health coverage for a child and the parent is eligible for family health coverage<br>through an insurer, the insurer shall:1.Permit the parent to enroll under family coverage any child who is otherwise eligible<br>for coverage without regard to any open enrollment restrictions and subject to the<br>prohibited practices provisions of this chapter;2.If a parent fails to provide health coverage for any child, enroll the child under family<br>coverage upon application by the child's other parent or by the department of human<br>services;3.Upon receipt of the national medical support notice issued under section<br>14-09-08.20 from the employer:a.Comply with the provisions of the national medical support notice;b.Within forty business days of the date of the national medical support notice,<br>take appropriate action pursuant to the notice; andc.Enroll the child, and the obligor if necessary, in the insurer's default plan, if any,<br>if required under subsection 2 of section 14-09-08.20; and4.Not disenroll or eliminate coverage for any child unless the insurer is provided<br>satisfactory written evidence that:a.The court or administrative order is no longer in effect; orb.The child is or will be enrolled with comparable coverage that will take effect no<br>later than the effective date of disenrollment.Page No. 126.1-36.5-04. Providing information and paying claims. If a child has health coveragethrough the insurer of a noncustodial parent, the insurer shall:1.Provide information to the custodial parent as may be necessary for the child to<br>obtain benefits through the health coverage;2.Permit the custodial parent, the provider of health care, with the custodial parent's<br>approval, or the department of human services, as the custodial parent's assignee,<br>to submit claims for covered services without the approval of the noncustodial<br>parent; and3.Make payment on claims submitted in accordance with subsection 2 directly to the<br>custodial parent, provider, or department, as their interests may appear.26.1-36.5-05.Authority and jurisdiction.This chapter is adopted pursuant to therequirements of sections 4301 and 13623 of Public Law 103-66 [107 Stat. 312; 29 U.S.C. 1161<br>et seq. and 42 U.S.C. 1396g-1]. The commissioner may take any action reasonably necessary<br>to enforce this chapter and section 26.1-36-12. Any insurer subject to the provisions of this<br>chapter or section 26.1-36-12 must submit to the jurisdiction of the commissioner and to the<br>courts of this state to the greatest extent permitted under state or federal law.Page No. 2Document Outlinechapter 26.1-36.5 health coverage for children
